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UGANDA: In Search of Better Medical Care

by Wambi Michael (bududua, uganda)

Wednesday, July 13, 2011

Inter Press Service

Even though government health services are free, Grace Nafungo Kutosi doesn’t mind paying the two thousand shillings (about one dollar) when she visits the non-governmental Beatrice Tierney Clinic in Bumwalukani village. In fact, paying the fee at the clinic, which is a 20-minute walk from her home, is cheaper than her having to travel to the nearest government clinic almost seven kilometres away.

'We were suffering a lot. Even if you endured the journey seven kilometres from your home to the (government) health centre, (there is a possibility that) you will not be treated. If you were lucky the nurses will give you Panadol and tell you to go and buy prescribed drugs elsewhere. Here we get all the medicine,' Kutosi said.

Government health care in Uganda has been free since 2001, but patients in the rural village of Bumwalukani, in Bududua district some 200 kilometres from Kampala, would rather pay a small user fee to their local independently-run clinic because they know they will get the services they need.

'You can come here when you are sick and you are sure of medication unlike the government hospital,' said Kutosi as she waited amidst mothers, children and men.

The Beatrice Tierney Clinic was founded by the Foundation for International Medical Relief for Children as a sick bay for pupils at Arlington Academy of Hope. It not only provides health care to students of the school but to the surrounding community.

The villagers have taken advantage of its existence to access treatment for their families and don’t mind paying the user fee of two thousand shillings per visit per adult. Children are treated for free.

'That is not a lot of money. Because you can use more than that if you were to visit Bududa hospital,' Kutosi said.

Residents of Bumwalukani are also fortunate because the clinic has a volunteer medical doctor working alongside the nurses. A government clinic is usually run by an enrolled nurse who works with a midwife, two nursing assistants and a health assistant.

Wilson Mangoye, a health outreach coordinator in Bumwalukani, and a regular user of the clinic, says the presence of qualified doctor has attracted patients from neighbouring districts who are in desperate search of better medical care.

'Sometimes we get patients from the regional referral hospital coming here for treatment because they are assured of the medicine,' he said.

Bulukwa said he did so because the services at local government hospitals were deplorable, especially for the poor who cannot bribe health workers. Services in government facilities are supposed to be free, but in many cases health workers extort money from patients desperate for services.

'The workers in government hospitals have no passion to serve; you cannot be respected as patients. Even cleaners can shout at you but you cannot say anything because you never know they could (put you in touch with) someone who can treat you,' said Bulukwa.

But despite charging a small user fee, the clinic is still under-resourced.

Dr. Lisa Umphrey, the resident doctor sits in a small blockhouse attending to her patients. She is a specialist in child-related disease like malaria, respiratory diseases like pneumonia, and malnutrition among others.

Umphrey said it is challenging to provide needed services for patients in an under-resourced clinic.

'Even with support from donations, there are too many patients that need our care. So we are forced to find creative ways to reach many patients, care for many diseases. We try to educate and reach communities to prevent the illnesses before they reach the clinic,' explained Umphrey.

The clinic, according Umphrey, attends to between 100 to150 patients per day. She says the inclusion of outreach programmes to the community has had some benefit because people now have some understanding of diseases and how to prevent them.

In the past government had attempted to start similar outreach programmes but they were not successful because of a lack of funds.

Health care provision and infrastructure in Uganda are chronically under-funded and highly variable in quality.

A system of ‘cost sharing’, whereby hospitals used to charge user fees was abolished by government because of intense pressure from activist groups and politicians who thought it was very costly to the majority of Ugandans who live on less than a dollar per day.

Asked whether the clinic was not contradicting government’s policy by reintroducing user fees Umphrey explained that it had been done in conjuction with the community.

'We used our outreach services to educate the entire community about the idea before we started. They embraced it because of the services and felt that they could contribute to it as well,' she said. However, there is a need for transparency on how the money is utilised.

'At the end of every month we have an open day where we inform the community what we did with their money,' she said. Money is used to purchase medicine and to pay for the transportation of patients to other health centres.